Drug Demand Reduction and HIV/AIDS
Scope of the Drug Problem in Afghanistan
Three decades of war instability have caused massive increases in poverty, insecurity, and the breakdown of social structures in Afghanistan. Coupled with the illegal cultivation of opium and the production of heroin, and despite a strong Islamic culture where all intoxicants are religiously forbidden, a silent increase in the demand for drugs has occurred across all sectors of Afghan society, burgeoned by easy availability and low prices of many drugs.
The 2009 Drug Use in Afghanistan survey confirms that the increased presence of drugs in Afghanistan over recent decades has also fuelled rising drug consumption, initially mainly among returning refugees, and increasingly through a domestic drug abuse culture exacerbated by poverty, desperation and lack of medical facilities. The survey estimates that drug users in Afghanistan are annually spending on average US $300 million on drugs.
Drug Abuse Among Returned Refugees
Around 40% of known drug users are returned refugees from Iran and Pakistan. Among these drug users risky activities including IDU (injecting drug use) are common, leading to the spread of HIV and other blood-borne diseases. Most Afghans have little access to accurate information of the risks and dangers of drug use, including overdose, dependency and addiction. High levels of illiteracy and lack of social and life skills to deal with the problems of daily living also increase the risk of drug use.
Drug Abuse Within Law Enforcement
Disturbingly high levels of drug use have also been detected among the Afghan National Police (ANP) turning into a serious concern to Afghanistan's Ministry of Interior (MoI). Large numbers of police officers test positive for drug use under the current Police validation system, a component of the Personnel Asset Inventory (PAI) programme led by the MoI. A recent United States Government Accountability Office (GAO) report, released in the first quarter of 2010, states that between 12-41% of police recruits in regional training centres tested positive for illicit substances and that the true percentage was likely to be higher. Given that the salaries of law enforcement officials are too low to maintain an addiction, drug use leaves law enforcement personnel increasingly susceptible to bribery.
Risk of epidemic HIV/AIDS in Afghanistan
Afghanistan currently has a low rate of HIV overall, but high risk behaviours among injecting drug users (IDUs), sex workers, truckers, along with returned refugees and deportees, may change this picture. Data from the John Hopkins University and National AIDS Control Programme (NACP) confirms that Afghanistan has evolved towards a 'concentrated' HIV epidemic, meaning that HIV prevalence is above 5% in at-least one at-risk population. The highest HIV prevalence is among IDUs in Herat, Kabul and Mazar-e-Sharif (7% in 2009), and Kabul (3%).
Exposure to contaminated drug injecting equipment is the main mode of transmission among the reported cases of HIV in Afghanistan. [1] In a study conducted among 464 male injecting drug users in Kabul, 3% tested positive for HIV, 50% had at some point shared syringes, 57% had previously been in prison, and 17% reported had injected drugs in prison. [2]
Prison settings often combine injecting drug use with risky sexual practices, leading to increased transmission rates of HIV. See Sarposa Prison, Kandahar Drug Use Survey (2010)
Lack of Drug Treatment Programmes
Despite accelerated efforts the current support for drug treatment and harm reduction falls short of Afghanistan's requirements in both quantity and quality. Long waiting lists abound, as there are simply not enough services to deal with the scale of the drug problem. Current capacity allows for uneven treatment of up to 9,000 addicts annually. Existing treatment is dominated by residential and home-based approaches, which focus on detoxification, residential rehabilitation and low-intensity aftercare.
Structured treatment is unavailable in a third of the country (10 out of 32 provinces). UNODC prioritizes assistance to these provinces as demand for treatment dramatically outweighs supply of services. In Kabul, Balkh, Kandahar, Herat, Farah, Balkh, Takhar, Ghazni, Jawzjan and Nangahar, very little structured treatment is available. Distressingly, following the decommissioning of the Counter Narcotics Trust Fund, several Ministry of Public Health (MoPH) treatment centres have closed or are in the process of closing. These include centres previously operating in Ghor, Kunduz and Nimroz; these provinces have not yet been allocated resources for future drug treatment centres by donors.
Concept Note on "Reducing Drug Demand and HIV in Afghanistan" (full text)
Current Projects
XWW/K05: Sub-Regional Project for the Provision of Comprehensive HIV Prevention and Care Services to Afghan Refugee Drug Users in Iran and Pakistan and Returnees in Afghanistan
